Audio Examples for Training Use – DA CPR (1 of 3) (Double-click speaker icon to play audio Right-click to stop) Completely missed need for CPR and agonals – Caller answers yes to the inquiry about consciousness but right away says she is out of it, not coherent, cannot talk. “staring in space”. Spent a great deal of time talking about yesterday and should have focused on right now and the patents level of consciousness. The caller described patient as “moaning” but the call receiver did not pursue this at all. Dilemma Hospice compassion – This is a good example of the kind of confusion that can occur when the patient is terminal or under hospice care etc. It would be a good idea to play this after talking about POLST or DNR orders. This is also a great example of the issue that callers usually do not answer “yes or no” questions with a “yes or no answer”. 911 call receiver does a great job in calming the caller and being empathetic. It’s not as easy as it sounds – Caller describes the patient as talking at first and then is very reluctant or afraid to answer questions. Call receiver gets right to consciousness and doesn’t give up, also does a good job trying to figure out what is described as “breathing lightly”. Patient was on his stomach and call-receiver has her get him on his back immediately. Call receiver is very reassuring and even when it is discovered that the patient is not really having a cardiac arrest, the call receiver made sure to tell caller not to have the patient exert himself etc. Patient had several classic ACS symptoms. Great pre-arrival instructions – call receiver fears that the patient may arrest after he hangs up but before responders arrive. When breathing is not normal, labored – Patient is described as “non-responsive” but opens eyes when spoken to. This is a good audio to play to focus on the question – “is the patient breathing normally?” The answer to that question is seldom “yes” or “no” it is usually, “kind of”, “I think so”, “it’s labored”, “once in a while”. This would be a great example to point out that “labored breathing” could mean something different to everyone. Agonals could be described as labored. This call receiver should have asked more questions to help the caller either describe the breathing or actually place the phone up to the patient to hear it themselves.

Audio Examples for Training Use – DA CPR (2 of 3) (Double-click speaker icon to play audio Single-click to stop) Good example of quick CPR and agonals – This call involved a couple that found a man passed out in a vehicle and the call receiver very quickly gets to the all- caller questions, has them drag the very heavy patient out of the car and begin chest compressions immediately. Agonals can be heard very distinctly. 2 min. until CPR good agonals – Patient described as being “in pain” because she is moaning and groaning. Also, husband cannot wake up his wife. Call receiver goes right to whether the chest is rising and falling but the caller is not really able to say yes or no. The caller keeps describing the patient as “taking a breath”. These are great examples of agonals but the call receiver spends a bit too much time with multiple attempts to confirm when we could have started CPR sooner. A bit of chaos after that but responders arrive pretty fast. Postictal breathing mistaken for agonals – This call would be a good example to play when you discuss seizures as they relate to cardiac arrest. Caller does say the patient is snoring which makes her think he is not breathing normally and when she asks to hear the breathing it is very clear that this is rhythmic breathing and just the normal thing you see when someone is postictal. Because hypoxic seizure related to cardiac arrest is often mistaken for “just a seizure” the call-receiver is most likely afraid that the callers are not describing the patient correctly. The rhythmic breathing that you hear on the call should be an indication that this person is postictal and not dead. Caller asks “what if he starts to come to?” and the call receiver says, “just keep doing the compressions” This man actually survives – This is a very confusing and chaotic call. Wife is initial caller but has the “nurse” with her and it just gets worse from there. Good example to play to talk about how far you go to get callers to start CPR. The patient has an implanted defibrillator/pacemaker. The call receiver gets some help from the dispatcher who joins the call to try to figure out why they are not starting CPR. This was a witnessed event and despite all the chaos and confusion, this patient survived this event. There is wasted time spent with the registered nurse looking for a stethoscope etc. and it is clear the dispatcher and call receiver are frustrated. This audio could prompt a discussion about calls from “medical” providers and the assumptions we at 911 have about their “abilities and knowledge”.

Audio Examples for Training Use – DA CPR (3 of 3) (Double-click speaker icon to play audio Single-click to stop) Poor start edited – A good example of a call where there is almost 5 min. spent and we never determine whether or not this patient really is breathing normally. The caller is very upset of course but most of the times calls like this come in with distraught callers and we have to have a mechanism or tools to help them focus. The call receiver does a pretty good job with that but as the caller describes the patient as “gasping for air once in a while” etc. it would have been a good idea to follow-up with that right away and ask about the chest rising and falling etc.